ACUPUNCTURE INSURANCE

Billing Codes Overview

If you’re an acupuncture provider who’s new to insurance billing, you may be wondering “Where can I find the right acupuncture CPT codes to use?” At Holistic Billing Services, we know this is a common concern when getting started, so we’ve provided a list of the most up-to-date codes for your practice.

We believe these codes are ones that most insurances will reimburse, categorized by the three main sources of revenue for your practice: acupuncture treatments, office visits and physical therapy-based treatments.

Acupuncture Treatment Billing Codes

Acupuncture services are always coded in 15-minute increments, so you will use one code for the initial 15 minutes of service and then a separate code for additional units of time. Acupuncture CPT codes will only vary if you include electronic stimulation in your treatment. Many of the services you will bill to insurance for acupuncture treatments will fall under the following four codes:

Initial Acupuncture
Code: 97810

Description:
Initial 15-minute insertion of needles and personal one-on-one contact with the patient. (Tip: do not report this in conjunction with 97813; use one or the other.)

Subsequent Unit of Acupuncture
Code: 97811

Description:
Use one unit per each additional 15 minutes of personal one-on-one contact with the patient after the initial 15 minutes, with re-insertion of needles. (You may use in conjunction with either 97810 or 97813.)

Initial Acupuncture with Electrical Simulation
Code: 97813

Description:
Initial 15-minute insertion of needles, personal one-on-one contact with the patient. (Tip: do not report in conjuction with 97810; use one or the other.) 

Subsequent Unit of Acupuncture with Electrical Stimulation
Code: 97814

Description:
Use one unit per each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles. (You may use in conjunction with either 97810 or 97813.)

Office Visit Billing Codes

Office visits (or evaluation and management services) can be billed on the initial patient evaluation and follow-up evaluations thereafter. A good rule of thumb is every 30 days or every sixth visit. Be sure not to bill these codes every time the patient receives acupuncture treatments because acupuncture codes 97810, 97813, 97811, and 97814 are intended to include evaluation and management as part of the overall daily treatment.

Evaluation/Management Limited
Code: 99201

Description:
Usually a 10-minute face-to-face session with patient, where presented problems are self-limited or minor; requires a problem-focused history, problem-focused examination, and straightforward medical decision-making.

Evaluation/Management Expanded
Code: 99202

Description:
Usually a 20-minute face-to-face session with patient, where presented problems are low to moderate severity; requires an expanded problem-focused history, an expanded problem-focused examination, and straightforward medical decision-making.

Evaluation/Management Detailed
Code: 99203

Description:
Usually a 30-minute face-to-face session with patient, where presented problems are of moderate severity; requires a detailed history, a detailed examination, and medical decision-making of low complexity.

Evaluation/Management Comprehensive
Code: 99204

Description:
Usually a 45-minute face-to-face session with patient, where presented problems are of moderate to high severity; requires a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity.

Physical Therapy-Based Treatments and Modalities Billing Codes

Many acupuncturists use a variety of treatments and modalities to help patients strengthen, relax, and heal their muscles. Here are a few used by acupuncturists in their daily practice:

Single Injection
Code: 97010

Description:
Tendon sheath, or ligament, aponeurosis (e.g., plantar “fascia”).

Injection of One/Two-Site Trigger Points
Code: 97016

Description:
One or two muscles.

Heat Therapy
Code: 97010

Description:
Application of a modality to one or more areas; hot or cold packs.

Cupping
Code: 97016

Description:
Use of vasopneumatic devices for cupping; may be considered reasonable and necessary for the application of pressure to an extremity for the purpose of reducing edema.

Infrared
Code: 97026

Description:
Application of infrared therapy is considered medically necessary for patients requiring the application of superficial heat in conjunction with other procedures or modalities to reduce or decrease pain/produce analgesia or reduce stiffness/tension, myalgia, spasm, or swelling.

Therapeutic Exercise
Code: 97110

Description:
One or more areas, each 15 minutes; therapeutic procedures to develop strength and endurance, range of motion, and flexibility with one-on-one patient contact.

Neuromuscular Reeducation
Code: 97112

Description:
Movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities with one-on-one patient contact.

Manual Therapy
Code: 97140

Description:
Techniques like mobilization and manipulation, manual lymphatic drainage, and manual traction; one or more regions, each 15 minutes with one-on-one patient contact.

Massage Therapy
Code: 97124

Description:
Effleurage, petrissage, and/or tapotement (stroking, compression, percussion) with one-on-one patient contact.

Kinetic Activities
Code: 97530

Description:
Dynamic activities to improve functional performance, each 15 minutes with one-on-one patient contact.